EPILEPSY Flashcards
what is important in AE for epilepsy ?
to be on high flow oxygen !!!
An 18 year old girl presents to A+E with a seizure
She has a known history of epilepsy and is under the neurology team at the hospital.
You have been told that she was last in hospital with seizures one month ago.
cause of current seizure ?
infection
drug substances used
most likely cause for this seizure is anti-epileptic non-compliance or withdrawal of medication.
alcohol
electrolyte disturbance; head injury or hypoglycaemia.
SOL
investigations ?
I would send blood tests for U&Es, Glucose, Calcium, Magnesium, Liver enzymes and FBC. I
!!!! if indicated I could also send bloods for toxicology screen.!!!!
I would also send bloods for anticonvulsant levels.!!!!
I would ask for an ECG if possible as well as regular monitoring of observations including HR, BP and Temperature.
!!!!!An urgent CT head should be considered if head injury is suspected to be the precipitant; a lumbar puncture will be necessary to exclude CNS infection.!!!!
!!!!An MRI will be important once the patient is more stable to identify structural abnormalities!!!!
!!!!I would also arrange am EEG to determine seizure type and epilepsy syndrome.!!!!
when starting phenytoin what should be considered ?
Phenytoin can cause cardiac dysrhythmias and so the patient should be attached to a cardiac monitor.
why is lorazepam better than diazepam?
lorazepam has strong cerebral binding, a long duration of action and does not accumulate in lipid stores
what is status epileptics ?
Status epilepticus is a single epileptic seizure lasting more than five minutes,
or two or more seizures within a five minute period, without the person returning to normal in between them.
Status epilepticus can be divided into both convulsive and non-convulsive
How should refractory status be managed?
Refractory status is where seizures continue beyond 60 minutes after initial therapy.
Refractory status should be treated by transferring the patient to ITU as they will require general anaesthesia (either propofol or thiopental). EEG monitoring should be commenced.
complications of status epilepticus are you aware of?
Hyperthermia
Acidosis (secondary to raised lactate)
Hypotension
Respiratory failure
Rhabdomyolysis
Aspiration
important to tell patients with status epileptics ?
LGV drivers or passenger carrying vehicle drivers should not drive for five year
advised to stop driving for six months and inform the DVLA
However, they should only return to driving if they have undergone recent assessment by a neurologist and there are no clinical factors or investigation results (eg, EEG, brain scan) which indicate that the risk of a further seizure is greater than 2% per annum
no relevant structural abnormalities on brain imaging and no definite epileptiform activity on EEG. If these conditions are not met then this is increased to 12 months
for patients with established epilepsy or those with multiple unprovoked seizures:
may qualify for a driving licence if they have been free from any seizure for 12 months
Do you as the doctor need to inform the DVLA
responsibility for informing the DVLA rests with the patient.
However, GMC guidance states that: ‘if a patient does pose a risk of serious harm to the public by continuing to drive when they are not fit to do so, the doctor should contact the DVLA or DVA, even if they do not have the patient’s consent to do so. These steps should only be taken as a last resort, if efforts to encourage the patient to act responsibly fail.’
Should a patient be started on anti-epileptic drugs following a first seizure?
Treatment is usually not recommended until after a second epileptic seizure. However it may be indicated after a first seizure if the individual has a neurological deficit, brain imaging shows a structural abnormality or the electroencephalograph (EEG) shows unequivocal epileptic activity.
